scholarly journals Early mobilisation following fragility hip fracture surgery: current trends and association with dicharge outcomes in a local tertiary hospital

2021 ◽  
Author(s):  
S Tan ◽  
A Vasireddy
Keyword(s):  
Hip Fracture ◽  
Functional Recovery ◽  
Early Mobilisation ◽  
Local Study ◽  
Fragility Hip Fracture ◽  
Hip Fracture Surgery ◽  
Current Trends ◽  
Significant Difference ◽  
Fracture Surgery ◽  
Early Functional Recovery

Introduction: Postoperative day 1 (POD1) mobilisation is a key clinical indicator for the fragility hip fracture surgery population. This study aimed to evaluate the current trends of POD1 mobilisation at our institution; and to review the relationships between early mobilisation and outcomes of early functional recovery, length of stay (LOS) and discharge destination. Methods: In this preliminary observational study, data pertaining to demographics, pre-morbid function, health status, injury and surgical factors, POD1 mobilisation status and clinical outcomes of interest were retrieved from eligible patients. Patients who attained POD1 ambulation formed the “Early Ambulation (EA)” Group while the remaining patients formed the “Delayed Ambulation (DA)” group. Data were analysed for any significant difference between the groups. Results: 115 patients were included in the analysis. The rate of patients achieving at least sitting out of bed on POD1 was 80.0% (92 patients) which was comparable with data available from international hip fracture audit databases. 55 patients (47.8%) formed the EA group and 60 patients (52.5%) formed the DA group. EA group was approximately nine times more likely to achieve independence in ambulation at discharge compared to the DA group (adjusted odds ratio 9.20; 95% Confidence Interval 1.50-56.45; p = 0.016). There were observed trends of shorter LOS and more proportion of home discharge in the EA group compared to DA group (p > 0.05). Conclusion: This is the first local study to offer benchmark of the POD1 mobilisation status for this population. Patients who attained POD1 ambulation had better early functional recovery.

scholarly journals 34 Discharge After Hip Fracture Surgery by Mobilisation Timing: Secondary Analysis of the UK National Hip Fracture Database

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i7-i11
Author(s):  
A Goubar ◽  
O Almilaji ◽  
F C Martin ◽  
C Potter ◽  
G D Jones ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Average Rate ◽  
Small Sample Size ◽  
Small Sample ◽  
Competing Risk ◽  
Hospital Death ◽  
Early Mobilisation ◽  
Hip Fracture Surgery ◽  
Risk Of Death ◽  
Fracture Surgery

Abstract Background To maximise the benefits of hip fracture surgery the National Institute for Health and Care Excellence Clinical Guideline recommends mobilisation on the day after hip fracture surgery based a low to moderate quality trial with a small sample size. There is a need to generate additional evidence to support early mobilisation as a new UK Best Practice Tariff (BPT). Objective To determine whether mobilisation timing was associated with the cumulative incidence of hospital discharge by 30-days after hip fracture surgery, accounting for potential confounders and the competing risk of in-hospital death. Method We examined data for 135,105 patients 60 years or older who underwent surgery for nonpathological first hip fracture between January 2014 and December 2016 in any hospital in England or Wales. We tested whether the cumulative incidences of discharge differed between those mobilised early (within 36 hours of surgery) and those mobilised late accounting for potential confounders and the competing risk of in-hospital death. Results 106,722 (79%) of patients first mobilised early. The average rate of discharge was 60.1 (95% CI 59.8–60.5) per 1,000 patient days, varying from 65.2 (95% CI 64.8–65.6) among those who mobilised early to 44.5 (95% CI 43.9–45.1) among those who mobilised late, accounting for the competing risk of death. By 30-days postoperatively, the crude and adjusted odds ratios of discharge were 2.26 (95% CI 2.2–2.32) and 1.93 (95% CI 1.86–1.99) respectively among those who first mobilised early compared to those who mobilised late, accounting for the competing risk of death. Conclusion Early mobilisation led to a near two fold increase in the adjusted odds of discharge by 30-days postoperatively. We recommend inclusion of mobilisation within 36 hours of surgery as a new UK BPT to help reduce delays to mobilisation currently experienced by one-fifth of patients surgically treated for hip fracture.

LOW DOSE HEPARIN PROPHYLAXIS IN HIP FRACTURE SURGEY -HEPARIN EFFECT; INHIBITORS; FIBRINOLYSIS AND INCIDENCE OF DVT

1987 ◽  
Author(s):  
J Kußmann ◽  
M Spannaql ◽  
J Boehnke ◽  
H G Kückel-haus ◽  
W Schramm
Keyword(s):  
Hip Fracture ◽  
Low Dose ◽  
Blood Collection ◽  
Hip Fracture Surgery ◽  
Significant Difference ◽  
Final Consideration ◽  
Heparin Activity ◽  
Fracture Surgery ◽  
Low Dose Heparin ◽  
Plasma Heparin

In a prospective studie 129 patients with hip fracture surgery under LDH-prophylaxis (3x5000 U Na-heparinat) were examined in order to find an answer tothe question, if there is a correlation between inhibitor activity, parameters of fibrinolysis, plasma heparin activity and the incidence of DVT.100 patients with ascending phlebography on day 7 to9 post op. were taken into final consideration (blood collection on admission and on day 1, 2, 4, 7 after surgery):1)Incidence of DVT : 17 %.2)Inhibitors: No difference between patients with and without DVT with respect to AT III activity and prot. C concentration ( prot. C activity in progress).3)Fibrinolysis: Elevated levels of DD-fragment (x = 1 780 mg/ml), t-PA Inhibitor (x = 31 AU) and fibrinogen (417 rng/dl) before operation due to preceding trauma. No significant difference between t-PA, t-PA inhibitor and antiplasmin with respect to DVT. Whileplasminogen concent was significantly increased in patients with DVT on day 4 and 7, DD-fragments had lower values on day 7 (x = 1395 / x = 2140 ng/ml).4)Heparin effect: Plasma heparin activity was assesed by an amidolytic anti ll^assay. Although plasmaticheparin action only represents one aspect of thromboprophylactic heparin-activity, there is an obvious difference between patients with and without DVT withrespect to plasmatic heparin activity( p <0.005).

scholarly journals Rivaroxaban versus aspirin in prevention of venous thromboembolism following total joint arthroplasty or hip fracture surgery: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Bangsheng Hu ◽  
Lianxiang Jiang ◽  
Haixia Tang ◽  
Meizhu Hu ◽  
Jun Yu ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Hip Fracture ◽  
Total Joint Arthroplasty ◽  
Meta Analysis ◽  
Joint Arthroplasty ◽  
Hip Fracture Surgery ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Cheap Alternative ◽  
Fracture Surgery

Abstract Objective To evaluates the efficacy and safety of rivaroxaban versus aspirin in prevention of venous thromboembolism (VTE) following total hip (THA) or knee arthroplasty (TKA) or hip fracture surgery. Methods Major databases were systematically searched for all relevant studies published in English up to October 2020. The meta-analysis was conducted using RevMan 5.3 software. Results In total, 7 studies were retrieved which contained 5133 patients. Among these patients, 2605 patients (50.8%) received rivaroxaban, whereas 2528 patients (49.2%) received aspirin. There were no statistical difference between aspirin and rivaroxaban for reducing VTE (RR = 0.75, 95% CI 0.50–1.11, I2 = 36%, p = 0.15), major bleeding (RR = 0.94, 95% CI 0.45–2.37, I2 = 21%, p = 0.95), and all-cause mortality (RR = 0.88, 95% CI 0.12–6.44, I2 = 0%, p = 0.90) between the two groups. Compared with aspirin, rivaroxaban significantly increased nonmajor bleeding (RR = 1.29, 95% CI 1.05–1.58, I2 = 0%, p = 0.02). Conclusion There was no significant difference between aspirin and rivaroxaban in prevention of venous thromboembolism following total joint arthroplasty or hip fracture surgery. Aspirin may be an effective, safe, convenient, and cheap alternative for prevention of VTE. Further large randomized studies are required to confirm these findings.

Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people

2006 ◽  
Vol 36 (11) ◽  
pp. 1635-1645 ◽  
Author(s):  
RICHARD C. OUDE VOSHAAR ◽  
SUBE BANERJEE ◽  
MIKE HORAN ◽  
ROBERT BALDWIN ◽  
NEIL PENDLETON ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Hip Fracture ◽  
Older People ◽  
Cognitive Functioning ◽  
Outcome Measures ◽  
Functional Recovery ◽  
Fear Of Falling ◽  
Hip Fracture Surgery ◽  
The Impact ◽  
Fracture Surgery

Background. Depression and cognitive functioning have a negative impact on functional recovery after hip fracture surgery in older people, and the same has been suggested for pain and fear of falling. These variables, however, have never been studied together, nor has the timing of psychiatric assessment been taken into account.Method. Two parallel, randomized controlled trials were undertaken aiming to prevent and treat depression after hip fracture surgery in older people. Multiple logistic regression analyses corrected for age and pre-morbid level of functioning were performed to evaluate the effect of depressive symptoms (15-item Geriatric Depression Scale, GDS), pain (Wong–Baker pain scale), cognitive functioning (Mini-mental State Examination, MMSE) and fear of falling (Modified Falls Efficacy Scale, MFES) within 2 weeks after surgery and 6 weeks later on functional recovery at 6 months. Main outcome measures were performance-based measures (up-and-go test, gait test, functional reach) and the self-report Sickness Impact Profile (SIP) questionnaire to assess the impact of the hip fracture on activities of daily living (ADL).Results. Two hundred and ninety-one patients participated and outcome measures for 187 (64%) patients were available at 6 months. All mental health variables interfered with functional recovery. However, in the final multivariate model, cognitive functioning and fear of falling assessed 6 weeks after surgery consistently predicted functional recovery, whereas pain and depressive symptoms were no longer significant.Conclusion. Fear of falling and cognitive functioning may be more important than pain and depression to predict functional recovery after hip fracture surgery. Rehabilitation strategies should take this into account.

scholarly journals Hip fracture surgery in mixed-use emergency theatres: is the infection risk increased? A retrospective matched cohort study

2017 ◽  
Vol 99 (8) ◽  
pp. 641-644
Author(s):  
SK Agarwal ◽  
AA Khan ◽  
M Solan ◽  
M Lemon
Keyword(s):  
Hip Fracture ◽  
Laminar Flow ◽  
Surgical Site Infections ◽  
Control Group ◽  
Risk Of Infection ◽  
Hip Fracture Surgery ◽  
Mixed Use ◽  
Increased Risk ◽  
Significant Difference ◽  
Fracture Surgery

Introduction The National Institute of Health and Care Excellence recommends that people with hip fracture should have surgery on the day of, or the day after, admission. However, there remains unacceptable variation in performance around the country, with a range of 13–91% of patients meeting this target. Dedicated trauma lists have insufficient capacity in many hospitals. We occasionally employ a mixed-use emergency theatre to facilitate early surgery. Increased risk of infection has been raised as a concern owing to microbial surface contamination from a preceding unclean case and lack of laminar flow in these theatres. The objective of this study was to investigate whether there is an increased risk of surgical site infections in patients who had hip fracture surgery in a mixed-use emergency theatre. Methods Between August 2010 and July 2014, 74 patients had hip fracture surgery in a mixed-use emergency theatre without laminar flow. This group was compared with a control group of patients who had hip fracture surgery in dedicated orthopaedic theatres with laminar flow. Infection was the primary outcome measured. Results There was no statistically significant difference in the rate of infection, length of stay or 30-day mortality, readmission or reoperation rates between the two groups. Conclusions Operating on hip fractures in mixed-use theatre did not lead to an increase in infection or other complications in our series. We feel that the risk of infection can be balanced against advantages of timely operation and it may therefore be justified to use these theatres when faced with lack of time on the trauma list. A much larger series would be required to investigate the effects of confounders.

scholarly journals 51 A Prospective Study on Falls Efficacy and Functional Outcomes after HIP Fracture Surgery in a Singapore Orthogeriatric Programme

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv13-iv17
Author(s):  
Kiat Sern Goh ◽  
Kiat Mun Serena ◽  
Thulasi Chandran
Keyword(s):  
Hip Fracture ◽  
Self Efficacy ◽  
Functional Outcomes ◽  
Community Hospital ◽  
Weight Bearing ◽  
Depression Scale ◽  
Community Dwelling ◽  
Fragility Hip Fracture ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Abstract Introduction Fear of Falling (FoF) is common after hip fracture and associated with adverse outcomes including impaired functional recovery and recurrent falls. The objective of this study was to measure self-efficacy related to falls and its association with functional outcomes after hip fracture surgery. Methods A prospective cohort study was performed on 106 community-dwelling elderly aged ≥65 years without dementia, admitted to a community hospital for rehabilitation after surgery for fragility hip fracture in Singapore. They were managed in an integrated multidisciplinary orthogeriatric programme, transitioning from acute orthopaedic unit to the affiliated community hospital. Falls Efficacy Scale (FES; range 10-100) was assessed on discharge. Main outcomes measured included Parker Mobility Score (PMS) and Modified Barthel Index (MBI) at 3 months. Results Key characteristics of the cohort were: mean age 79.4(SD 6.38); female 74%, Chinese 83%, pre-fracture PMS 6.7(SD 2.7); pre-fracture MBI 81.1(SD 20.9); mean FES score 32.0(SD 23.7). At 3 months, mean PMS was 3.97(SD 2.51); mean MBI was 73(SD 20.1), demonstrating that the cohort overall did not regain their pre-morbid functional levels. FES was negatively correlated with both 3-month MBI and PMS with coefficients -0.592 and -0.523 respectively (p&lt;0.001). FES was negatively associated with 3-month MBI and PMS in the multiple linear regression model, having adjusted for demographics, comorbidities, pre-fracture MBI and PMS, MMSE, geriatric depression scale, and post-operative weight-bearing status, with corresponding βs -0.26(95%CI -0.49 to -0.02;p=0.032) and -0.03(95%CI -0.06 to -0.00;p=0.044). Conclusion FoF is a potentially modifiable factor linked to adverse functional outcomes in hip fracture rehabilitation, indicating the necessity to address falls self-efficacy as a major component of assessment and intervention, whilst further exploring the local validity and applicability of various instruments measuring FoF. Further studies need to be conducted on the evolving patterns of FoF over time and its impact on longer-term functional and psychosocial outcomes.

Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients

Bone ◽  
2012 ◽  
Vol 50 (6) ◽  
pp. 1343-1350 ◽  
Author(s):  
Sang-Min Kim ◽  
Young-Wan Moon ◽  
Seung-Jae Lim ◽  
Byung-Koo Yoon ◽  
Yong-Ki Min ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Functional Recovery ◽  
Hip Fracture Surgery ◽  
Second Fracture ◽  
Prediction Of Survival ◽  
Fracture Surgery ◽  
Surgery In Elderly
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